Présentation PowerPoint - USDA-Farm Service Agency · PPT file · Web...
Transcript of Présentation PowerPoint - USDA-Farm Service Agency · PPT file · Web...
Quality of Relief Diets: New ProductsDr. Buddhima LokugeDoctors Without Borders
Appropriate Complementary Foods
Updated by Brown & Dewey, Food Nutr Bull 2003
WHO: Brown, Allen & Dewey, 1998
InsufficientHealth Services &
Unhealthy Environment
undernutrition
DiseaseInadequate Dietary Intake
Inadequate Carefor Mothers
and Children
Inadequate Education
Resources & ControlHuman, Economic &
Organizational
PotentialResources
Political and Ideological Superstructure
Economic Structure
UnderlyingCauses
ImmediateCauses
BasicCauses
Manifestation
MultilateralInstitutions
Development Banks
IMF
BilateralInstitutions
PrivateSector
Inadequate Access to
Food
International Conference on Nutrition, Rome, 1992
• “Among refugees and displaced populations, high rates of malnutrition and micronutrient deficiencies associated with high rates of mortality continue to occur.
• Donor countries and involved organizations must therefore ensure that the nutrient content of food used for emergency food aid meets nutritional requirements”.
SC-UK, ENN study of Supplementary Feeding programsConclusions Efficacy:• Out of 67 SFPs, less than 40 % have a recovery rate above
75 %• Defaulter rate appears to be the main determinant of
recovery rate. – programme design and management ?– population’s opportunity costs ?
Maradi, NigerWasting 11.6% (18.5%)Stunting 62.2% (52.0%)U5MR 231/1000 (374/1000)
DHS 2006 (1998) Maradi Region
39,158 admissions (94% SEVERE)60% of admissions in 13 weeks95% < 85 cm height91.4% cure, 3.2% death, 4.7% default, 29 day length of stay64.5% direct into outpatient care
Maradi 2005
nutriment type Ideficiency disease
nutriment type II growth failure & wasting
systemic effects
MalnutritionGolden hypothesis
iron, copper, selenium, calcium, iodine, vitamins A, B, D, E, K
nitrogen, essential amino acids sodium, potassium, chloride,
phosphorus, sulfur, zinc, magnesium
Dense in nutrients (F-100 formula)Dense in energy (5x F-100)Ready to eat, no water neededDifficult to contaminateIndividual & adaptable packagingBetter capacity & coverageSimplified outpatient treatmentMultiple, decentralized sites
Better qualityEarly diagnosis (recruitment)Improved intensive care
Ready to Use Therapeutic Food
(RUTF)
Ready-to-use foodsNew therapeutic products & strategies
Seasonality severe malnutritionAdmissions of children with W/H < 70% (NCHS) weekly proportion of total inclusions in the year
Guidan Roumji, Niger, 2003-2005
0%
1%
2%
3%
4%
5%
6%
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Week number
% o
f all
year
adm
issi
ons 2003
200420053-year Average
Targeted Distribution RUSF
Guidan Roumdji, 2007
Attendance/ Drop out from RUSF distribution
0
10,000
20,000
30,000
40,000
50,000
60,000
Beneficiaries 62,922 62,902 62,865 62,756 62,680
Drop out 0 20 57 166 242
May June July August Sept
Dr Mike Golden, Oct 2007
2007 2010 - 2012
20% WFP FOOD
FORTIFIED
100%+ MICRONUTRIENT
NEEDS MET
FORTIFICATION
COMPLEMENTARY FOODS
SPRINKLES
Corn Soy
BlendGeneral
Food BasketCereals, Pulses,
Legumes, Vegetable Oil, Salt, CSB
Nutrition StrategyWFP: FEEDING BETTER FOOD…
DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level.
+ micronutrients
Going beyond current paradigms and practice
Malnutrition: a neglected disease
• 2000 Further extension of treatment to outpatients by Collins and Concern
• 2004 Spearheaded by Valid International - use of outpatient management by many NGOs particularly Concern + SCF. Data presented to show dramatic increase in coverage and low mortality
• 2006 extension of treatment to moderately malnourished by MSF
• 2007: lipid based spreads used to prevent malnutrition at population level in Niger (MSF)
• 1994 First use of F100 in Rwanda after genocide. Results revolutionary! Extensive use of F100 and F75 by most NGOs (Grellety)
• 1995: refusal of patients in North Uganda to come for treatment (Lord’s Resistance Army kidnapping children) – need for ready-to-use food recognised by Grellety
• 1996: ACF scientific committee discussed options and developed the idea of a paste based on premixes seen in Liberia (Golden, Grellety, Briend)
• 1997: successful use of local fortified foods for treatment of SAM by ICDDRB (Kituri and Halva)
Local diets• Briend has shown by linear programming that it is not possible to get the same nutrient concentrations from local diets without fortification with some minerals and vitamins.
• The best diets contain a large variety of local foods mixed together
• However, addition of mineral and vitamin mix to mixtures of local foods can indeed result in a diet that emulates F100 and derivative diets
• There remains the problems of anti-nutrients and the necessity to test new diets against the gold standard (F100/RUTF).